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Lancet (London, England) Jun 2023Tonsillectomy is regularly performed in adults with acute tonsillitis, but with scarce evidence. A reduction in tonsillectomies has coincided with an increase in acute... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Tonsillectomy is regularly performed in adults with acute tonsillitis, but with scarce evidence. A reduction in tonsillectomies has coincided with an increase in acute adult hospitalisation for tonsillitis complications. We aimed to assess the clinical effectiveness and cost-effectiveness of conservative management versus tonsillectomy in patients with recurrent acute tonsillitis.
METHODS
This pragmatic multicentre, open-label, randomised controlled trial was conducted in 27 hospitals in the UK. Participants were adults aged 16 years or older who were newly referred to secondary care otolaryngology clinics with recurrent acute tonsillitis. Patients were randomly assigned (1:1) to receive tonsillectomy or conservative management using random permuted blocks of variable length. Stratification by recruiting centre and baseline symptom severity was assessed using the Tonsil Outcome Inventory-14 score (categories defined as mild 0-35, moderate 36-48, or severe 49-70). Participants in the tonsillectomy group received elective surgery to dissect the palatine tonsils within 8 weeks after random assignment and those in the conservative management group received standard non-surgical care during 24 months. The primary outcome was the number of sore throat days collected during 24 months after random assignment, reported once per week with a text message. The primary analysis was done in the intention-to-treat (ITT) population. This study is registered with the ISRCTN registry, 55284102.
FINDINGS
Between May 11, 2015, and April 30, 2018, 4165 participants with recurrent acute tonsillitis were assessed for eligibility and 3712 were excluded. 453 eligible participants were randomly assigned (233 in the immediate tonsillectomy group vs 220 in the conservative management group). 429 (95%) patients were included in the primary ITT analysis (224 vs 205). The median age of participants was 23 years (IQR 19-30), with 355 (78%) females and 97 (21%) males. Most participants were White (407 [90%]). Participants in the immediate tonsillectomy group had fewer days of sore throat during 24 months than those in the conservative management group (median 23 days [IQR 11-46] vs 30 days [14-65]). After adjustment for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group (n=224) compared with the conservative management group (n=205) was 0·53 (95% CI 0·43 to 0·65; <0·0001). 191 adverse events in 90 (39%) of 231 participants were deemed related to tonsillectomy. The most common adverse event was bleeding (54 events in 44 [19%] participants). No deaths occurred during the study.
INTERPRETATION
Compared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis.
FUNDING
National Institute for Health Research.
Topics: Male; Female; Humans; Adult; Young Adult; Tonsillectomy; Conservative Treatment; Tonsillitis; Pharyngitis; Respiration Disorders; Pain; United Kingdom
PubMed: 37209706
DOI: 10.1016/S0140-6736(23)00519-6 -
Otolaryngologia Polska = the Polish... Jun 2020<b>Introduction:</b> Tonsillectomy belongs to the most frequently performed surgical treatments; however, the necessity of its performance is questioned....
<b>Introduction:</b> Tonsillectomy belongs to the most frequently performed surgical treatments; however, the necessity of its performance is questioned. Therefore, there are many attempts to unify and define the indications for the procedure. <br><b>Aim:</b> The main objective of the current dissertation was an analysis of the clinical symptoms occurring in patients qualified for tonsillectomy, as well as a comparison of those with a histopathological image of the removed tonsils in a repeatedly carried out, unified pathomorphological examination. The secondary objective was the designation of the demographic profile, existing comorbidities, and complications in the form of postoperative bleeding in patients after tonsillectomy in own material. <br><b>Material and method:</b> A retrospective analysis of 301 procedures of palatine tonsil removal was performed, which were completed in the years 2017-2019 at the Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery of the Military Institute of Medicine, Warsaw, Poland. The indications were defined on the grounds of data from the anamnesis. Based on unified criteria, the removed material was divided into 2 groups: with the signs of Chronic Tonsillitis (CT) as well as Tonsillar Hyperthrophy (TH). <br><b>Results:</b> The average size of tonsils was the greatest in a group of patients under 35 years of age, and smallest in the group over 51 years of age. As patients aged, the reduction in size of the palatal tonsils was observed. In the examined group, the histopathological diagnosis in the form of HT was found in 165 patients (54.8%), while CT in 136 (45.2%). It was proven that the larger the tonsils in the clinical picture, the more often the histopathological image responded to HT. Among clinical symptoms reported by patients qualified for tonsillectomy, the following were observed: recurring tonsil inflammation in 211 (70.1%), snoring and sleep apnea in 47 (15.6%), as well as sleep apnea in 33 (11%) patients. Primary bleeding occurred in 10 patients (3.34%), and secondary in 8 patients (2.66%). The most common comorbidities were cardiovascular burdens. <br><b>Conclusions:</b> For most cases, clinical symptoms were confirmed by adequate features of removed material in histopathological examination. The most common histopathological diagnosis was tonsillar hyperthrophy.
Topics: Adult; Female; Humans; Male; Middle Aged; Poland; Retrospective Studies; Tonsillectomy; Tonsillitis; Treatment Outcome; Young Adult
PubMed: 33028738
DOI: 10.5604/01.3001.0014.1612 -
Ear, Nose, & Throat Journal Mar 2024There has been a subjective increase in the number of patients presenting for tonsil stones to our pediatric otolaryngology clinic. This may be related to frequent...
There has been a subjective increase in the number of patients presenting for tonsil stones to our pediatric otolaryngology clinic. This may be related to frequent viewing of videos on the social media application, TikTok, pertaining to tonsil stones.
Topics: Child; Humans; Palatine Tonsil; Tonsillitis; Social Media; Pharyngeal Diseases
PubMed: 34569296
DOI: 10.1177/01455613211038340 -
Auris, Nasus, Larynx Aug 2020to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published... (Review)
Review
OBJECTIVE
to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures.
METHODS
We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients.
RESULTS
within the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%).
CONCLUSION
ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.
Topics: Adenoids; Betacoronavirus; COVID-19; Coronavirus Infections; Cough; Diarrhea; Dyspnea; Erythema; Fatigue; Fever; Headache; Humans; Myalgia; Nasal Obstruction; Olfaction Disorders; Otorhinolaryngologic Diseases; Palatine Tonsil; Pandemics; Pharyngitis; Pneumonia, Viral; Respiratory Tract Infections; SARS-CoV-2
PubMed: 32586739
DOI: 10.1016/j.anl.2020.06.003 -
Pneumologie (Stuttgart, Germany) Apr 2020Sleep disordered breathing disorders in children are of a high clinical relevance. They do not only affect a large proportion of the children's lives in terms of time...
Sleep disordered breathing disorders in children are of a high clinical relevance. They do not only affect a large proportion of the children's lives in terms of time but they impact on the thriving, cardiovascular function and cognitive development. Different developmental factors have to be considered in the interpretation of sleep studies in children. Adeno-tonsillar hypertrophy is the most frequent reason for paediatric sleep disordered breathing, however the spectrum of aetiologies is very large. Syndromic cranio facial malformations and metabolic disorders are often associated with a very high risk of relevant sleep disordered breathing. Correct and child-oriented diagnostics are essential to enable adequate therapy.
Topics: Child; Humans; Palatine Tonsil; Polysomnography; Sleep Apnea Syndromes; Snoring; Tonsillitis
PubMed: 32274782
DOI: 10.1055/a-0977-6236 -
Nature Immunology Jul 2023Fibroblastic reticular cells (FRCs) direct the interaction and activation of immune cells in discrete microenvironments of lymphoid organs. Despite their important role...
Fibroblastic reticular cells (FRCs) direct the interaction and activation of immune cells in discrete microenvironments of lymphoid organs. Despite their important role in steering innate and adaptive immunity, the age- and inflammation-associated changes in the molecular identity and functional properties of human FRCs have remained largely unknown. Here, we show that human tonsillar FRCs undergo dynamic reprogramming during life and respond vigorously to inflammatory perturbation in comparison to other stromal cell types. The peptidase inhibitor 16 (PI16)-expressing reticular cell (PI16 RC) subset of adult tonsils exhibited the strongest inflammation-associated structural remodeling. Interactome analysis combined with ex vivo and in vitro validation revealed that T cell activity within subepithelial niches is controlled by distinct molecular pathways during PI16 RC-lymphocyte interaction. In sum, the topological and molecular definition of the human tonsillar stromal cell landscape reveals PI16 RCs as a specialized FRC niche at the core of mucosal immune responses in the oropharynx.
Topics: Humans; T-Lymphocytes; Palatine Tonsil; Fibroblasts; Lymphocytes; Inflammation; Carrier Proteins; Glycoproteins
PubMed: 37202490
DOI: 10.1038/s41590-023-01502-4 -
Anales de Pediatria Nov 2023
Topics: Humans; Palatine Tonsil; Lymphangioma
PubMed: 37798221
DOI: 10.1016/j.anpede.2023.09.010 -
Journal of Surgical Case Reports May 2023Salivary tumors that involve the tonsil are rare, representing 0.5% of salivary neoplasms. Most tumors arise from the parotid glands. Rare studies have been reported in...
Salivary tumors that involve the tonsil are rare, representing 0.5% of salivary neoplasms. Most tumors arise from the parotid glands. Rare studies have been reported in the literature regarding pleomorphic adenomas affecting the tonsil. Patients are usually asymptomatic and present with a slow-growing, mobile and painless mass. Radiological examinations are usually unable to differentiate benign from malignant tumors in most cases. There is low recurrence with complete excision of the tumor. The prognosis is excellent except in the rare cases of malignant transformation. This report describes the management of a case of pleomorphic adenoma affecting the palatine tonsils and the difficulty regarding the histopathological diagnosis.
PubMed: 37255959
DOI: 10.1093/jscr/rjad261